Initial Development and Validation of the Moral Distress Scale for Licensed Clinical Social Workers (MDS-LCSW)

Background and Purpose: Moral distress is defined as negative stress resulting from a situation in which the social worker knows the right action to take but is unable to fully execute it due to internal constraints (e.g., social worker’s knowledge, skills, and beliefs) and/or external constraints  (e.g., work environment and demands, legal requirements, professional requirements). Moral distress negatively impacts individuals, clients, and organizations specifically affecting individuals’ physical and mental health, as well as their work related productivity. In fact, when moral distress is not appropriately addressed and mitigated, it has been associated with decreased job performance, decreased job satisfaction, increased burnout rate, and increased turnover rate. Moral distress is inherent in social work practice, given its status of a value-based profession and the importance of social workers’ ability to engage in ethically sound actions and practices.  Currently, there is no existing scale to assess how moral distress manifests in social work practice.  The current study is an important first step in addressing this existing and significant gap in the literature.

Methods:  Data were collected from licensed clinical social workers in the state of Florida.  Of the 6,870 surveys distributed, 2,773 opened the survey, and 666 were returned resulting in a 24.02 % response rate. An expert panel was utilized to evaluate the instrument’s content validity. Subsequently, exploratory and confirmatory factor analyses were performed, in addition to construct validity analyses. Cronbach’s alphas were used to ascertain internal consistency of the scale.

Results: Initial results indicate that the proposed scale has good content and factorial validity, as well as strong internal consistency.  Model fit indices obtained were as follows: χ ² (291) = 1058.48, RMSEA = 0.063, CFI = 0.938, TLI = 0.926 and SRMR = 0.055.  Reliabilities for the global scale and the three subscales were found to be strong respectively (α = .95, α  = .93, α = .93, and α  = .88).  Convergent validity was examined using two measures: job satisfaction and self-efficacy.  Discriminant validity was assessed by one construct, religiosity.  The acquired results demonstrated support for both convergent and discriminant validities, with negative and significant correlations obtained for job satisfaction and self-efficacy, and a statistically non-significant correlation obtained for religiosity.

Conclusions and Implications: Initial results confirm the existing hypotheses in the extant literature that moral distress is present in social work practice. The MDS-LCSW has good content validity and strong internal consistency to measure this phenomenon. Subsequent evaluation of the measure is warranted in order to continue to assess its validity, reliability, and utility. Further understanding of moral distress can point to prevention and interventions strategies, which in turn may positively impact physical and psychological wellbeing, job satisfaction, and turnover rates.